The 1978 Italian psychiatric reform law brought about fundamental changes in the system of care by blocking admissions to mental hospitals and developing alternative community and general-hospital services. The paper discusses the possibly different course and use of the public psychiatric system had the reform not been implemented. Comparisons with other European countries are also presented to identify similarities and differences in the patterns of change of their psychiatric systems. Finally, available data on current first-ever psychiatric admissions in Italy are used to estimate the number of people who would have experienced institutionalization in an asylum in the 30+ years since the reform.